Order  Detail: # 20874

Order  Date
09/30/2021
Customer Name
Sylvia Smilen Trust
Statement Note
Invoice # 1072 (Old Invoice # system). Customer Sylvia Smilen Trust: Rate = 15.00/hr. Mrs. Sherman: Submitted to John Hancock: Claim #: R12 004 977 via fax @800.638.4040 on Oct 2, 2021@3:13PM. Successful fax confirmation Oct 2, 2021@3:34PM  
Date Task Description Units Total
09/01/2021 Standing Unit of Care for Sylvia Smilen/hr. 09/01/2021 Care: 2:00PM-8:00PM 6.00 90.00
09/02/2021 Standing Unit of Care for Sylvia Smilen/hr. 09/02/2021 Care: 2:00PM-7:00PM 5.00 75.00
09/03/2021 Standing Unit of Care for Sylvia Smilen/hr. 09/03/2021 Care: 9:00AM-7:00PM 10.00 150.00
09/08/2021 Standing Unit of Care for Sylvia Smilen/hr. 09/08/2021 Care: 3:00PM-9:00PM 6.00 90.00
09/10/2021 Standing Unit of Care for Sylvia Smilen/hr. 09/10/2021 Care: 3:00PM-9:00PM 6.00 90.00
09/12/2021 Standing Unit of Care for Sylvia Smilen/hr. 09/12/2021 Care: 5:00PM-9:00PM 4.00 60.00
09/15/2021 Standing Unit of Care for Sylvia Smilen/hr. 09/15/2021 Care: 3:00PM-9:00PM 6.00 90.00
09/17/2021 Standing Unit of Care for Sylvia Smilen/hr. 09/17/2021 Care: 12:00PM-9:00PM 9.00 135.00
09/19/2021 Standing Unit of Care for Sylvia Smilen/hr. 09/19/2021 Care: 8:30AM-11:30AM 3.00 45.00
09/22/2021 Standing Unit of Care for Sylvia Smilen/hr. 09/22/2021 Care: 3:00PM-10:00PM 7.00 105.00
09/24/2021 Standing Unit of Care for Sylvia Smilen/hr. 09/24/2021 Care: 3:00PM-9:00PM 6.00 90.00
09/29/2021 Standing Unit of Care for Sylvia Smilen/hr. 09/29/2021 Care: 3:00PM-9:00PM 6.00 90.00
    Order Totals: 74.00 $1,110.00
Invoice #20874 was created on Thursday, September 30, 2021
This Invoice was paid on Monday, October 18, 2021

Source Document: Local Storage: Source Docs\John Hancock\Confirmation_JHLTC_DocScan_20211103_Fax.pdf;Local Storage: Source Docs\John Hancock\JHLTC_DocScan_20211003.pdf